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Related Experiment Videos

Differentiating Crohn's disease from intestinal tuberculosis.

Saurabh Kedia1, Prasenjit Das2, Kumble Seetharama Madhusudhan3

  • 1Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India. dr.saurabhkedia@aiims.edu.

World Journal of Gastroenterology
|February 1, 2019
PubMed
Summary

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Differentiating Crohn's disease and intestinal tuberculosis remains challenging. New models show promise, but definitive diagnosis often still requires an anti-tubercular therapy trial, delaying treatment for Crohn's disease.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Diagnostic Imaging

Background:

  • Distinguishing Crohn's disease (CD) from intestinal tuberculosis (ITB) is a clinical challenge, particularly in developing nations with high ITB prevalence and rising inflammatory bowel disease burdens.
  • While clinical, endoscopic, histologic, and radiologic features differ, definitive diagnostic markers for ITB (caseation necrosis, positive acid-fast bacilli smear/culture, necrotic lymph nodes) have limited sensitivity.
  • Existing multi-parametric predictive models for differentiating CD and ITB suffer from complexity, small sample sizes, and lack of external validation.

Purpose of the Study:

  • To review current diagnostic modalities for differentiating Crohn's disease and intestinal tuberculosis.
  • To highlight the limitations of existing diagnostic criteria and predictive models.
  • To discuss emerging parameters and the persistent need for improved diagnostic accuracy.
Keywords:
Computed tomographic enterographyCrohn's diseaseEndoscopyGranulomaIntestinal tuberculosis

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Main Methods:

  • Review of clinical, endoscopic, histologic, microbiologic, and radiologic features differentiating CD and ITB.
  • Analysis of the sensitivity and limitations of exclusive diagnostic markers for ITB.
  • Evaluation of multi-parametric predictive models, including recent advancements like Bayesian meta-analysis and CT-based scores.
  • Discussion on the role and limitations of therapeutic anti-tubercular therapy (ATT) trials in diagnosis.

Main Results:

  • Exclusive diagnostic features for ITB (caseation, AFB positivity, necrotic lymph nodes) exhibit poor sensitivity.
  • Current predictive models are complex and lack broad validation.
  • Emerging parameters like T-regulatory cell enumeration and updated CT scores offer potential improvements.
  • Therapeutic ATT trials are often required but delay CD diagnosis and carry risks.

Conclusions:

  • Accurate differentiation between CD and ITB remains difficult, necessitating improved diagnostic tools.
  • Reducing reliance on empirical anti-tubercular therapy trials is crucial for timely Crohn's disease diagnosis and management.
  • Further research and validation of novel diagnostic parameters are needed to enhance differentiation accuracy.